title: Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis.
abstract: BACKGROUND
  In clinical trials, only about 60% of subjects report an excellent response to intranasal steroids, suggesting a need to add therapies to intranasal steroids to provide additional efficacy.
  
  
  OBJECTIVE
  To determine whether the combination of fluticasone furoate and oxymetazoline is more efficacious than either agent alone, and to determine whether rhinitis medicamentosa develops after treatment.
  
  
  METHODS
  We performed a double-blind, double-dummy, randomized, placebo-controlled parallel study. Sixty patients with perennial allergy were randomized to 4 weeks of once-a-night treatment with fluticasone furoate, oxymetazoline hydrochloride, the combination, or placebo. They were monitored during treatment and for 2 weeks posttreatment.
  
  
  RESULTS
  The total nasal symptom score over the 4 weeks of treatment was lower with the combination (median, 143; range, 30-316) compared with treatment with placebo (262; 116-358) and oxymetazoline alone (219; 78-385; ANOVA, P = .04). When acoustic rhinometry was compared between the groups at the end of 4 weeks of treatment, the combination resulted in significantly higher nasal volume (mean + SEM, 15.8 + 1.1 mL; P< .03) compared with both placebo (12.1 + 0.9 mL) and oxymetazoline (12.4 + 0.8 mL) alone. The quality of life data showed no significant differences among the groups. Peak flow showed a nonsignificant improvement with the groups on fluticasone furoate. There was no evidence of rhinitis medicamentosa.
  
  
  CONCLUSIONS
  The addition of oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. The lack of development of rhinitis medicamentosa suggests the need for a large multicenter study to develop a once-a-day combination of an intranasal steroid and a long-acting topical decongestant.
authors.affiliation: Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center, and Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA.
authors.forename: Fuad M
authors.initials: FM
authors.lastname: Baroody
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.forename: Laura
authors.initials: L
authors.lastname: Gavanescu
authors.forename: Marcy
authors.initials: M
authors.lastname: DeTineo
authors.forename: Robert M
authors.initials: RM
authors.lastname: Naclerio
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D014663:Nasal Decongestants / Q000008:administration & dosage* / Q000009:adverse effects; D010109:Oxymetazoline / Q000008:administration & dosage* / Q000009:adverse effects; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy*
chemical_list: D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D014663:Nasal Decongestants; D010109:Oxymetazoline; C523187:fluticasone furoate